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Plenty of health care jobs, but often low-paying for those without degrees, Brookings report finds

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Many tout the security and good pay of health care jobs, but a new Brookings study says that there has been a proliferation of lower-paying jobs in the sector. In this photo, nursing home workers belonging to SEIU demonstrate over pay and hours at Menorah Park in Beachwood in July 2013.
(Scott Shaw, The Plain Dealer)

"I think that health care jobs present a mixed picture," said Martha Ross, a fellow in the Brookings Metropolitan Policy Program, who co-authored the report. "There is certainly an area of opportunity because there is job growth, but a number of these occupations have such low wages. That is a problem."

The report refers to jobs not requiring undergraduate degrees as pre-baccalaureate or pre-BA occupations. With more than 53,000 of them, they make up 54.2 percent of all the health care jobs in Greater Cleveland. In first place, with 19,065 pre-BA workers, is the category of nursing, psychiatric and home health aides, who make a median annual salary of $22,000. Their numbers have increased by more than 45 percent since 2000.

Not all pre-BA jobs are low paying. They include positions, usually requiring an associate degree, such as registered nurse, which pay solidly middle-class salaries. In fact, the registered nurse category came in second place with 11,282 workers, who make a median annual salary of $56,000. Their ranks have increased 20 percent since 2000.

Of the 10 occupations on the pre-BA list, four pay median wages between $22,000 and $27,000. Three have median salaries between $33,300 and $36,000. Three offer median salaries between $40,000 and $56,000.

But the higher-paying jobs tend not to be as plentiful as the lower-paying ones. This is seen in that the median wage for the 10 health care occupations is $32,000. For non-health care pre-BA workers it is higher -- $35,000.

The higher median wage for non-health care workers may surprise many, since health care - especially in Northeast Ohio - is touted as an employment sector offering stable jobs with good salaries. The Brookings report shows that such prospects are less certain for those without at least an undergraduate degree.

But one thing is certain. Health care is a growing industry in Greater Cleveland, especially for pre-BA workers. Since 2000, the total number of pre-BA health care workers has increased by 40.5 percent. Employment for their non-health care counterparts has decreased by more than 12 percent.

At the same time, both sets of workers have experienced a decrease in earnings. It was steeper for the non-health care workers, who saw wages decline by more than 13 percent. The 10 health care occupations saw a decline of nearly 10 percent.

Some of the health care occupations that saw the largest percentage increase in workers also experienced the deepest wage cuts. For example, workers in the category that includes home health aides saw earnings decrease 14.2 percent since 2000. The number of personal care aides increased by more than 226 percent, but those workers saw their wages decline by 18.5 percent.

Ross said even being in a growth industry wasn't enough to set these health care workers apart from trends occurring in the overall labor force.

"They were not immune to the recession and other economic factors that have caused a decline in wages for all pre-baccalaureate workers," she said.

The report looked at health care salaries in the 100 largest metropolitan areas in the country. The Cleveland-Elyria-Mentor metro area includes Cuyahoga, Geauga, Lake, Lorain and Medina counties,

Greater Cleveland ranks 22 among the 100 largest metros in the share that pre-BA workers represent of the total health care labor force. More than 54 percent are pre-BA workers. In Greater Akron, nearly 53 percent are pre-BA workers, ranking that metro 28. Greater Youngstown, where more than 57 percent of the health care workers are pre-BA, ranks eight.

"It not clear cut good or bad," Ross said of the rankings. "This isn't one of those cases where it is really good to be number one and terrible to be 100, like when we're ranking unemployment."

Ross said low wages are reason for concern. However, in a time when there is pressure on the health care industry to reduce costs, increasing salaries could be difficult. She said perhaps raises could be justified by increasing the skill level of low-wage pre-BA workers, such as home health aides.

Ross gave the example of a pilot program in California, where home health aides are becoming active members of a client's home care team, which usually only included doctors, social workers and other professionals. Now integrated into the team, these home health aides are being taught how to monitor the client's condition and also provide some health coaching. The goal is to lower emergency room visits and hospitalizations, in an effort to reduce medical costs.

"They could take a small portion of these savings from emergency room and hospitalizations that were avoided, and put them into wages," Ross said.

Caldwell said these workers already have a high level of responsibility caring for clients, many of whom have complex medical conditions. He said raises are in order even without requiring them to upskill.

"I think right now, that these workers are already going above and beyond," he said. "They are being paid poverty wages that aren't enough to support their families."

Caldwell is concerned about who will pay for such training. He recalls how a requirement that home care workers take a CPR class, costing about $75, was problematic for many of these workers. The modest fee caused a financial hardship because they make so little. He said these workers often aren't paid when they attend required training that conflicts with their work schedules.

"If you are going to require additional training and skills, then employers need to offer that at no cost to the employee, Caldwell said. "The employers are getting a return on their investment. You don't need to put that additional financial strain on the backs of the workers."

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